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Z Gastroenterol 2019; 57(04): 473-483
DOI: 10.1055/a-0838-6371
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Perceived distress, personality characteristics, coping strategies and psychosocial impairments in a national German multicenter cohort of patients with Crohn’s disease and ulcerative colitis

Psychosocial impairments in IBD: Data from a national German multicenter cohortStresswahrnehmung, Persönlichkeitsmerkmale, psychosoziale Beeinträchtigungen und Bewältigungsstrategien bei Patienten mit chronisch-entzündlichen DarmerkrankungenPsychosoziale Beeinträchtigungen bei Patienten mit chronisch-entzündlichen Darmerkrankungen
Vanessa A. Petruo   *
1   Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Germany
,
Ekaterina Krauss   *
2   Department of Medicine II, Justus-Liebig University Giessen, Germany
,
Anika Kleist
3   Department of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany
,
Juliane Hardt
4   Berlin Institute of Health (BIH), Clinical Research Unit (CRU) – Biostatistics, Berlin, Germany
5   Institute of Biometry and Clinical Epidemiology (iBikE), Charité – Universitätsmedizin Berlin AND Berlin Institute of Health (BIH), Berlin, Germany
6   Institute for Social Medicine and Epidemiology, University of Lübeck, Germany
,
Karsten Hake
7   University of Rostock, Clinic for Psychosomatics and Psychotherapic Medicine, Rostock, Germany
,
Julia Peirano
8   Psychotherapy practice with focus on IBD, Hamburg, Germany
,
Thomas Krause
9   Gastroenterological practice, Kassel, Germany
,
Robert Ehehalt
10   Gastroenterological practice, Heidelberg, Germany
,
Philipp von Arnauld de la Perriére
11   Gastroenterological practice, Lüneburg, Germany
,
Jürgen Büning
12   Department of Gastroenterology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany and Gastroenterological Practice, Lübeck, Germany
,
Oliver Treml
13   Specialized Medical Center, Hagen, Germany
,
Norbert Krauss
14   Center of Visceral Medicine, Gastroenterology, Endoscopy and Surgery, Justus-Liebig University Giessen, Giessen, Germany
,
Heinz Albrecht
3   Department of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany
,
Gisela Felten
15   Gastroenterological Practice, Herne, Germany
,
Uta Hermannspahn
16   Municipal Clinic of Landau i.d. Pfalz, Germany
,
Ulrike Burkhardt
17   Gastroenterological Practice, Plauen, Germany
,
Marc Eisold
18   Gastroenterological Practice, Moessingen, Germany
,
Nils Teich
19   Gastroenterological Practice, Leipzig, Germany
,
Britta Siegmund
20   Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Medical Clinic I, Berlin, Germany
,
Christian Maaser
21   Outpatient’s Department of Gastroenterology, University Teaching Hospital Lüneburg, Lüneburg, Germany
,
Bernd Bokemeyer
22   Gastroenterological practice, Minden
23   University Hospital of Schleswig-Holstein, Campus Kiel, Medical Clinic I, Kiel, Germany
,
Daniel C. Baumgart
24   Department of Gastroenterology and Hepatology. Charité Medical School, Humboldt-University, Berlin, Germany
25   Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
,
Markus F. Neurath
3   Department of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany
,
Jonas Mudter
3   Department of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany
26   Department of Gastroenterology and Infectiology, Helios Clinic, Schwerin, Germany
,
German IBD Study Group (GISG) KND › Author Affiliations
Further Information

Publication History

29 October 2018

17 January 2019

Publication Date:
09 April 2019 (online)

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Abstract

Background and aims This study examined differences in personality, psychological distress, and stress coping in inflammatory bowel disease (IBD) depending on type of disease and disease activity. We compared patients suffering from Crohn’s disease (CD) and ulcerative colitis (UC) with controls. While the literature is replete with distinctive features of the pathogenesis of IBD, the specific differences in psychological impairments are not well studied.

Methods In this German national multicenter study, participants were recruited from 32 centers. Two hundred ninety-seven questionnaires were included, delivering vast information on disease status and psychological well-being based on validated instruments with a total of 285 variables.

Results CD patients were more affected by psychological impairments than patients suffering from UC or controls. Importantly, patients with active CD scored higher in neuroticism (p < 0.01), psychological distress (p < 0.001) and maladaptive stress coping (escape, p = 0.03; rumination, p < 0.03), but less need for social support (p = 0.001) than controls. In contrast, patients suffering from active UC showed psychological distress (p < 0.04) and maladaptive coping (avoidance, p < 0.03; escape, p = 0.01). Patients in remission seemed to be less affected. In particular, patients with UC in remission were not inflicted by psychological impairments. The group of CD patients in remission however, showed insecurity (p < 0.01) and paranoid ideation (p = 0.04).

Conclusions We identified specific aspects of psychological impairment in IBD depending on disease and disease activity. Our results underscore the need for psychological support and treatment particularly in active CD.

Zusammenfassung

Hintergrund und Ziele Diese Studie untersuchte Unterschiede in der Persönlichkeit, psychische Belastung und Stressbewältigung bei chronisch-entzündlichen Darmerkrankungen (CED) in Abhängigkeit von der Art der Erkrankung und der Krankheitsaktivität. Wir verglichen Patienten mit Morbus Crohn (CD) und Colitis ulcerosa (UC) mit Kontrollgruppen. Während die Literatur zu charakteristischen Merkmalen der Pathogenese von IBD zahlreich ist, sind die spezifischen Unterschiede in den psychischen Beeinträchtigungen nicht ausreichend untersucht.

Methoden In dieser deutschen nationalen Multicenterstudie wurden Teilnehmer aus 32 Zentren rekrutiert. Es wurden 297 Fragebögen mit umfassenden Informationen über den Krankheitsstatus und das psychische Wohlbefinden auf der Grundlage validierter psychosozialer Instrumente mit insgesamt 285 Items evaluiert.

Ergebnisse CD-Patienten waren stärker von psychischen Beeinträchtigungen betroffen als Patienten mit UC oder Kontrollen. Wichtig ist, dass Patienten mit aktiver CD in den Bereichen Neurotizismus (p < 0,01), psychische Belastung (p < 0,001) und maladaptive Stressbewältigung (p < 0,03) höhere Werte, aber weniger Bedarf für soziale Unterstützung (p = 0,001) als Kontrollen aufwiesen. Im Gegensatz dazu zeigten Patienten, die an aktiver UC litten, psychische Belastung (p < 0,04) und maladaptive Coping (Vermeidung, p < 0,03; Flucht, p = 0,01). Patienten in Remission schienen weniger betroffen zu sein. Die Gruppe der CD-Patienten in Remission zeigte jedoch Unsicherheit (p < 0,01).

Schlussfolgerungen Wir identifizierten spezifische Aspekte der psychischen Beeinträchtigung bei IBD abhängig von Krankheit und Krankheitsaktivität. Unsere Ergebnisse untermauern den Bedarf an psychologischer Unterstützung und Behandlung, insbesondere bei aktiver CD.

Key words

Crohn’s disease - ulcerative colitis - psychosocial distress

Schlüsselwörter

Morbus Crohn - Colitis ulcerosa - Chronisch-entzündliche Darmerkrankung

* These authors contributed equally.


 

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